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  Citation statistics : Table of Contents
   2007| May-June  | Volume 55 | Issue 3  
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Global variation and pattern changes in epidemiology of uveitis
SR Rathinam, P Namperumalsamy
May-June 2007, 55(3):173-183
DOI:10.4103/0301-4738.31936  PMID:17456933
Uveitis, a complex intraocular inflammatory disease results from several etiological entities. Causes of uveitis are known to vary in different populations depending upon the ecological, racial and socioeconomic variations of the population studied. Tropical countries are unique in their climate, prevailing pathogens and in the existing diseases, which further influence the epidemiological and geographical distribution of specific entities. We provide an overview of the pattern of uveitis of 15221 cases in 24 case series reported from several countries over 35 years (1972-2007) and we integrate it with our experience of an additional 8759 cases seen over six years (1996-2001) at a large community-based eye hospital. Uveitis accounted for 0.8% of our hospital-based outpatient visits. The uveitis was idiopathic in 44.6%, the most commonly identified entities in the cohort included leptospiral uveitis (9.7%), tuberculous uveitis (5.6%) and herpetic uveitis (4.9%). The most common uveitis in children below 16 years (616 patients; 7.0% of the total cohort) was pediatric parasitic anterior uveitis, (182 children, 29.5% of the pediatric cohort), whereas the most common uveitis in patients above 60 years (642 patients; 7.3% of the total cohort) was herpetic anterior uveitis, (78 patients, 12.1% of the elderly cohort). Etiologies varied with the age group of the patients. As in other tropical countries, a high prevalence of infectious uveitis was seen in this population.
  74 22,278 4,832
Primary intraocular lens implantation in the first two years of life: Safety profile and visual results
Jagat Ram, Gagandeep Singh Brar, Sushmita Kaushik, Jaspreet Sukhija, Supratik Bandyopadhyay, Amod Gupta
May-June 2007, 55(3):185-189
DOI:10.4103/0301-4738.31937  PMID:17456934
Purpose: To study the safety profile of primary intraocular lens (IOL) implantation in the first two years of life. Materials and Methods: A prospective nonrandomized, interventional study was done at the tertiary care center. Forty-five eyes of 27 children (aged three weeks to two years) with congenital cataract who underwent phacoaspiration with continuous curvilinear capsulorrhexis combined with primary posterior capsulotomy and anterior vitrectomy with in the bag placement of IOL at primary surgery were included. Outcome measures were clarity of visual axis, postoperative inflammation, fixation pattern and retinoscopy. Results: The mean IOL power was 23.95 ± 0.87 diopter (D) (range 22D to 27D). Follow-up ranged from 12 months to 48 months (mean 18 ± 9.13 months). In infants, hypermetropia decreased from 6.60D ± 2.64D at one week postoperatively to 3.03D ± 2.53D at one year following surgery and 4.78D ± 1.93D to 2.56D ± 1.5D in children older than one year at the time of surgery. Re-opacification of the central visual axis was observed in six eyes (13.3%). Significant posterior synechiae due to irido-capsular adhesion was seen in seven eyes (15.6%). Five of these seven eyes also had significant posterior capsular opacification. Conclusions: Meticulously performed primary IOL implantation and primary posterior capsulorrhexis with anterior vitrectomy in the first two years of life is a safe and effective method of aphakic correction.
  14 10,712 2,100
Endogenous endophthalmitis in a rheumatoid patient on tumor necrosis factor alpha blocker
Pankaj Kumar Agarwal, Mick Gallaghar, Elizabeth Murphy, Meena Virdi
May-June 2007, 55(3):230-232
DOI:10.4103/0301-4738.31951  PMID:17456948
The development of anti-tumor necrosis factor (TNF) therapies is a milestone in the therapy of rheumatic diseases. It is of concern whether all potential undesired complications of therapy have been evaluated within clinical trials which have led to treatment approval. Specialists prescribing TNF blockers should be aware of the unusual and severe complications that can occur. We describe a case of endogenous endophthalmitis in a rheumatoid patient on TNF alpha blocker.
  9 6,190 1,533
Anterior chamber exudative mass due to Scedosporium apiospermum in an immunocompetent individual
Sandeep Shankar, Jyotirmay Biswas, Lingam Gopal, R Bagyalakshmi, Lily Therese, Nishikant J Borse
May-June 2007, 55(3):226-227
DOI:10.4103/0301-4738.31949  PMID:17456946
Endogenous intraocular infection of fungal etiology is extremely rare in an immunocompetent individual. Usually, an antecedent history of trauma, surgery, intravenous drug abuse or an immunocompromized state can be elicited. Scedosporium apiospermum is a known cause of keratomycosis after traumatic implantation and can cause fatal disseminated infection in immunocompromized patients. However, cases of S. apiospermum intraocular infection in immunocompetent individuals have been very rarely reported in literature. We report here a case of an anterior chamber exudative mass due to S. apiospermum in an immunocompetent individual which was managed successfully with anterior chamber wash and intravitreal injection of voriconazole.
  8 6,190 1,514
Visual acuity and contrast sensitivity outcomes in Indian eyes undergoing photodynamic therapy with intravitreal injection of triamcinolone acetonide in age-related macular degeneration
Atul Kumar, Subijay Sinha, Vikram Kumar
May-June 2007, 55(3):207-211
DOI:10.4103/0301-4738.31942  PMID:17456939
Purpose: To evaluate photodynamic therapy (PDT) with verteporfin along with intravitreal triamcinolone acetonide (IVTA) in the treatment of neovascular age-related macular degeneration (AMD). Materials and Methods: This prospective interventional case series included 23 patients (23 eyes) of choroidal neovascularization due to neovascular AMD who were treated with PDT with verteporfin followed by an injection of 4 mg IVTA. The main outcome measures were visual acuity (VA), contrast sensitivity, retreatment frequency with PDT (and triamcinolone) and frequency of side-effects. Results: Twenty-three eyes underwent PDT with verteporfin followed by IVTA one week later. All patients were followed up for one year. Initial VA ranged from 20/32 to 20/800 and final VA ranged from 20/40 to 20/500 at the end of 12 months. VA stabilized (that is loss/gain <2 lines) in 19 (82%) eyes. Contrast sensitivity also improved in 16/23 eyes (70%). Lesion type and patient's age had no influence on the outcome, but baseline VA had a borderline statistically significant effect ( P =0.059). Six eyes (27%) had an increase in intraocular pressure that required therapy. There were no cases of endophthalmitis, but four eyes (18%) developed significant cataract that required surgery during the follow-up period. Conclusion : The combination of PDT along with IVTA improves contrast sensitivity and stabilizes vision during one-year follow-up.
  8 6,745 1,585
Phacoemulsification and pars plana vitrectomy: A combined procedure
Vandana Jain, Dharmesh Kar, S Natarajan, Debraj Shome, Hitendra Mehta, Hijab Mehta, Chaitra Jayadev, Nishikant Borse
May-June 2007, 55(3):203-206
DOI:10.4103/0301-4738.31941  PMID:17456938
Aim: To describe the results of a combined procedure including phacoemulsification, insertion of posterior chamber intraocular lens (PCIOL) and pars plana vitrectomy (PPV) in eyes with vitreoretinal pathology and coexisting significant cataract. Design: Retrospective, consecutive, noncomparative, interventional case series. Materials and Methods: Medical records of patients who had undergone phacoemulsification, PPV and PCIOL implantation as a combined procedure between January 2000 and December 2004 were retrospectively reviewed. The main outcome measures were the anatomical success of retina, defined as reattached retina, intraoperative and postoperative complications and functional success in terms of final best corrected visual acuity. Results: In all, 65 eyes of 64 patients were included. The mean age of the patients was 50.9 years ± 17.1 (range, five to 82 years). Vitreous hemorrhage with or without retinal detachment (19 eyes, 29.2%) was the most common indication for the vitreoretinal procedure. Primary anatomical success of retina was achieved in 59 eyes (90.7%). Visual acuity improved in 48 eyes (73.8%), was unchanged in 12 eyes (18.5%) and deteriorated in five eyes (7.7%). Postoperative inflammation was significantly more in the subgroup of previously vitrectomized eyes (42%) ( P =0.014, Fisher exact test) compared to those which underwent primary vitrectomy. Conclusions: Combined surgery is a feasible option for patients with vitreoretinal diseases and cataract.
  7 9,128 1,717
Unilateral hypopyon in a child as a first and sole presentation in relapsing acute lymphoblastic leukemia
Neeraj Wadhwa, Rajpal Vohra, Dinesh Shrey, VK Iyer, Satpal Garg
May-June 2007, 55(3):223-224
DOI:10.4103/0301-4738.31947  PMID:17456944
Ocular manifestations form a part of the spectrum of varied clinical presentations in leukemias. Most of the ophthalmic manifestations are related to central nervous system leukemia and bone marrow relapse. We report a case of acute unilateral hypopyon uveitis as an initial presenting feature of relapsing acute lymphoblastic leukemia (ALL) in a pediatric patient. Anterior chamber paracentesis was performed in a four-year-old male child presenting with unilateral treatment-resistant hypopyon after remission of ALL. Examination of aqueous humor aspirate revealed presence of malignant cells. Atypical hypopyon, even unilateral can be an indication of relapsing ALL in a child.
  6 6,991 1,621
Role of fine needle aspiration cytology in diagnosis of eyelid sebaceous carcinoma
Rajat Maheshwari, Sejal Maheshwari, Satish Shekde
May-June 2007, 55(3):217-219
DOI:10.4103/0301-4738.31944  PMID:17456941
Sebaceous carcinoma of the ocular adnexa is a malignant neoplasm which can exhibit aggressive local behavior and can metastasize to regional lymph nodes and distant organs. The neoplasm is known to masquerade as other benign and less malignant lesions, resulting in delay in diagnosis and relative high morbidity and mortality. Fine needle aspiration cytology (FNAC) of recurrent upper eyelid nodules treated elsewhere as chalazion was done. Cytological smears were suggestive of malignancy. Subsequently histopathology confirmed the diagnosis of sebaceous gland carcinoma. Eyelid reconstruction was done after histopathologically confirmed tumor-free margins. The article highlights the role of FNAC in early diagnosis and subsequent appropriate surgical management of eyelid sebaceous gland carcinoma to prevent recurrence and metastasis.
  5 7,915 1,601
Evaluation of retinal nerve fiber layer thickness measurement following laser in situ keratomileusis using scanning laser polarimetry
Tanuj Dada, Sunil Chaudhary, Rajamani Muralidhar, Soman Nair, Ramanjit Sihota, Rasik B Vajpayee
May-June 2007, 55(3):191-194
DOI:10.4103/0301-4738.31938  PMID:17456935
Aim: To evaluate the effect of laser-assisted in situ keratomileusis (LASIK) on the measurement of retinal nerve fiber layer thickness by scanning laser polarimetry using customized corneal compensation in myopes. Materials and Methods: Scanning laser polarimetry was performed on 54 eyes of 54 healthy patients with myopia using the glaucoma diagnostics variable corneal compensation (GDx VCC) instrument (Laser Diagnostic Technologies, San Diego, California) before and a week after LASIK. The various parameters were compared using the Student's t test. Results: No statistically significant change was observed in any of the retinal nerve fiber layer parameters before and after LASIK. Conclusions: While the measurement of retinal nerve fiber layer thickness by scanning laser polarimetry is affected by anterior segment birefringent properties and LASIK would be expected to produce changes in the same, customized corneal compensation using the GDx VCC seems to adequately compensate for these changes.
  5 7,402 1,570
Craniodiaphyseal dysplasia: An unusual cause of recurrent dacryocystitis
G Shivanand, H Kandpal
May-June 2007, 55(3):219-221
DOI:10.4103/0301-4738.31945  PMID:17456942
We describe a rare syndrome characterized by severe craniofacial hyperostosis, sclerosis, obliteration of paranasal sinuses and foramina of skull base, in a 10-year-old female child who presented with abnormal facial features and recurrent dacryocystitis due to narrowing of nasolacrimal duct.
  4 15,657 1,515
Traumatic expulsive aniridia after phacoemulsification
Avinash Prabhu, Harish Nayak, Prasad Palimar
May-June 2007, 55(3):232-233
DOI:10.4103/0301-4738.31952  PMID:17456949
Blunt trauma is usually associated with severe ocular damage particularly in eyes following cataract surgery. Small, self-sealing incision cataract surgery is changing the pattern of presentation of such cases, with relatively favorable outcomes. We describe a case of blunt trauma following phacoemulsification leading to aniridia.
  3 6,008 1,406
Parinaud's syndrome in a patient with thalamic infarction due to cerebral venous thrombosis
Ashok Menon, Ani Sreedhar, D Anilkumar, TP Ittyerah
May-June 2007, 55(3):237-238
DOI:10.4103/0301-4738.31954  PMID:17456951
  3 8,103 1,488
Subconjunctival larva migrans caused by sparganum
B Mukherjee, J Biswas, M Raman
May-June 2007, 55(3):242-243
DOI:10.4103/0301-4738.31959  PMID:17456956
  3 5,356 1,389
Lipoprotein(a) as a risk factor for diabetic retinopathy in patients with type 2 diabetes mellitus
Rupali Chopra, Jaison G Saramma, John Mary, Abraham Rebecca
May-June 2007, 55(3):195-198
DOI:10.4103/0301-4738.31939  PMID:17456936
Aims: To estimate serum lipoprotein(a) [Lp(a)] levels in patients with type 2 diabetes mellitus with and without diabetic retinopathy and to determine the correlation, if any, between serum Lp(a) levels and severity of diabetic retinopathy. Materials and Methods: The study included a total of 200 patients of type 2 diabetes mellitus out of which 100 patients who had no retinopathy served as the control group and 100 patients with diabetic retinopathy formed the study group. A detailed fundus examination was done with dilated pupil. The Lp(a) levels were measured quantitatively in fasting venous samples by an immunoturbidimetric method using commercially available kits (Clonital). Statistical Analysis Used: Group comparisons involving qualitative measures were carried out using Chi square test. ANOVA procedure was applied for comparing group means. Logistic regression analysis was performed for independent factors associated with diabetic retinopathy. Results: The average Lp(a) levels in the study group (68.5 mg/dl) were significantly higher than in the control group (25.1 mg/dl) ( P < 0.001). The Lp(a) levels were found to increase with increasing severity of diabetic retinopathy. Conclusions: Serum Lp(a) levels are significantly raised in patients with diabetic retinopathy as compared to those with no retinopathy.
  3 6,387 1,738
Analysis of juvenile idiopathic arthritis associated uveitis in India over the last 16 years
S Sudharshan, Jyotirmay Biswas, Sudha K Ganesh
May-June 2007, 55(3):199-202
DOI:10.4103/0301-4738.31940  PMID:17456937
Aim: Juvenile idiopathic arthritis (JIA) associated uveitis is one of the most common causes of visual morbidity in children. We report the systemic, clinical and investigational features of a cohort of all cases of JIA associated uveitis seen at our referral uveitis clinic between 1988 and 2004. Study Design: Retrospective case series Materials and Methods: All patients of JIA seen at the uveitis clinic of tertiary eye care hospital, between 1988 and 2004 with minimum follow up of 3 months were included. Complete history and ophthalmic evaluation and findings on each visit were noted. Ocular complications were identified and recorded. Results of laboratory investigations and diagnostic as well as therapeutic procedures were analyzed. A rheumatologist managed systemic status. Results: There were 40 patients (64 eyes) with JIA. Thirty four patients (85%) had pauciarticular type and 6 patients (15%) had polyarticular type of JIA. Complicated cataract and band shaped keratopathy were seen in 38 eyes (63%) and 37 eyes (62%) respectively. Twenty-two patients (17 bilateral and 5 unilateral) were treated with immunosuppressives and in 19 of these patients, the disease went into remission. Twenty-three eyes (38%) had improvement in visual acuity while in 27 eyes (45%), the vision remained stable and in 10 eyes (17%), vision deteriorated despite therapy. Conclusion: In India, JIA associated uveitis commonly presented in pauciarticular type with preponderance in males. Rheumatoid arthritis factor and anti nuclear antibodies were not as common as compared to the western population. Among long-term treatment options, immunosuppressives are a better choice. Ocular surgery was performed when mandatory for visual rehabilitation.
  3 7,202 1,791
Can the Bruckner test be used as a rapid screening test to detect significant refractive errors in children?
Mihir T Kothari
May-June 2007, 55(3):213-215
DOI:10.4103/0301-4738.31943  PMID:17456940
Purpose: To assess the suitability of Brückner test as a screening test to detect significant refractive errors in children. Materials and Methods: A pediatric ophthalmologist prospectively observed the size and location of pupillary crescent on Brückner test as hyperopic, myopic or astigmatic. This was compared with the cycloplegic refraction. Detailed ophthalmic examination was done for all. Sensitivity, specificity, positive predictive value and negative predictive value of Brückner test were determined for the defined cutoff levels of ametropia. Results: Ninety-six subjects were examined. Mean age was 8.6 years (range 1 to 16 years). Brückner test could be completed for all; the time taken to complete this test was 10 seconds per subject. The ophthalmologist identified 131 eyes as ametropic, 61 as emmetropic. The Brückner test had sensitivity 91%, specificity 72.8%, positive predictive value 85.5% and negative predictive value 83.6%. Of 10 false negatives four had compound hypermetropic astigmatism and three had myopia. Conclusions: Brückner test can be used to rapidly screen the children for significant refractive errors. The potential benefits from such use may be maximized if programs use the test with lower crescent measurement cutoffs, a crescent measurement ruler and a distance fixation target.
  3 13,254 1,967
Institutional review boards and new patient privacy issues in publication
Thomas J Liesegang
May-June 2007, 55(3):169-171
DOI:10.4103/0301-4738.31935  PMID:17456932
  2 6,167 1,568
Panophthalmitis due to Aspergillus in an acquired immunodeficiency syndrome patient: Clinicopathological study of a case
Jyotirmay Biswas, Chekitaan Singh, Bipasha Mukherjee, GVN Rama Kumar
May-June 2007, 55(3):239-240
DOI:10.4103/0301-4738.31957  PMID:17456953
  2 4,766 1,373
Herniation of the anterior lens capsule
Nolette MG Pereira, Anand Dev, Haripriya Aravind
May-June 2007, 55(3):228-230
DOI:10.4103/0301-4738.31950  PMID:17456947
Herniation of the anterior lens capsule is a rare abnormality in which the capsule bulges forward in the pupillary area. This herniation can be mistaken for an anterior lenticonus where both the capsule and the cortex bulge forward. The exact pathology behind this finding is still unclear. We report the clinical, ultrasound biomicroscopy (UBM) and histopathological findings of a case of herniation of the anterior lens capsule. UBM helped to differentiate this entity from anterior lenticonus. Light microscopy revealed capsular splitting suggestive of capsular delamination and collection of fluid (aqueous) in the area of herniation giving it a characteristic appearance.
  1 5,722 1,396
Ophthalmic pathology: An illustrated guide for clinician
Jyotirmay Biswas
May-June 2007, 55(3):244-244
  - 4,581 1,374
Mastermind ophthalmology
May-June 2007, 55(3):244-244
  - 12,547 1,956
Optical coherence tomography following successful management of endophthalmitis
Ramandeep Singh, Vishali Gupta, Amod Gupta, Mangat R Dogra
May-June 2007, 55(3):234-235
DOI:10.4103/0301-4738.31953  PMID:17456950
Optical coherence tomography (OCT) was done in 20 eyes to detect causes of poor visual outcome, at least three months after successful management of endophthalmitis, which obtained clear media and best corrected visual acuity of < 20/40. Only four (20%) eyes had normal foveal contour on OCT. Eleven (55%) eyes showed treatable lesions, including epiretinal membrane with macular thickening in five (25%), epiretinal membrane without macular thickening in three (15%), cystoid macular edema in two (10%) and subfoveal serous detachment in one (5%) eye. Five eyes (25%) had foveal atrophy. OCT was helpful in segregating treatable conditions like cystoid macular edema from nontreatable causes like neurosensory atrophy in the postendophthalmitis patients.
  - 5,435 1,453
Double combined pigment epithelial and retinal hamartomas in a single eye: An optical coherence tomographic study
Vasumathy Vedantham, Jyothsna Rajagopal
May-June 2007, 55(3):221-222
DOI:10.4103/0301-4738.31946  PMID:17456943
Combined retinal pigment epithelial and retinal hamartomas are focal malformations composed of overgrowth of mature glial, vascular and pigmented cells. They are usually solitary and unilateral. In addition there are only a few optical coherence tomographic reports of the same. We report a rare case of twin hamartomas in the same eye and their unique optical coherence tomographic findings that are different from previous reports.
  - 5,173 1,385
Serous macular detachment associated with dysplastic disc
Lingam Gopal, Chetan Rao, Sumita Sharma
May-June 2007, 55(3):224-225
DOI:10.4103/0301-4738.31948  PMID:17456945
The article describes a case of abnormal looking optic disc (dysplastic) associated with serous macular detachment similar to what is described in cases of optic pit. However clinically as well as on fluorescein angiography, no optic pit or coloboma could be identified. Gas injection, prone positioning and laser along the temporal border of the disc could correct the macular detachment.
  - 6,363 1,514
Heavy eye phenomenon in association with zonular cataracts
Sudipto Bhatta, K Ali Qazi
May-June 2007, 55(3):241-242
DOI:10.4103/0301-4738.31958  PMID:17456955
  - 5,063 1,170
"Reverse" optic capture complicating retained viscoelastic in capsular bag following phacoemulsification
Supratik Bandyopadhyay, Gagandeep Singh Brar, Jaspreet Sukhija, Jagat Ram, Amod Gupta
May-June 2007, 55(3):238-239
DOI:10.4103/0301-4738.31955  PMID:17456952
  - 5,233 1,382
Ultrastructural study of a contusion cataract
MJ Saldanha, N Saha
May-June 2007, 55(3):239-239
DOI:10.4103/0301-4738.31956  PMID:17456954
  - 4,501 1,329